Current status and challenges of clinical trial on adenocarcinoma of esophagogastric junction

Abstract

The incidence of adenocarcinoma of esophagogastric junction (AEG) has been increasing in recent years and has become a major health problem worldwide. The completed phase III clinical trials have revealed that perioperative chemotherapy and radiochemotherapy can significantly improve prognosis and reduce local recurrence in patients with locally advanced AEG. The sudden emergence of targeted therapy and immunotherapy based on chemotherapy has showed a broad prospect. The location and gross type of tumors can provide valuable information for clinical decision making. Siewert classification is widely used in the world, which is helpful to the choice of the best surgical method. Partial gastrectomy and subtotal esophagectomy with thorough mediastinal lymph node dissection via right thorax approach and total gastrectomy with abdominal lymph node dissection are suitable for Siewert types I and III respectively. There is no consensus on the scope of lymph node dissection in Siewert type II procedure and further research is needed. In addition, regarding the rule of abdominal aortic lymph node metastasis and whether it is necessary to clean the para-aortic lymph nodes in patients with AEG, further research is still required.